“Currently, the U.S. admits more than 1.5 million legal and illegal immigrants every year, with more than 70 percent coming to the country through the process known as “chain migration” whereby newly naturalized citizens can bring an UNLIMITED relatives to the U.S. In the next 20 years, the current U.S. legal immigration system is on track to import 15 million new foreign-born voters. Between 7 and 8 million of those foreign-born will arrive in the U.S. through chain migration.” JOHN BINDER

Wednesday, July 20, 2016

UnitedHealth cuts Obamacare options for tens of thousands

By Kate Randall 20 July 2016

UnitedHealth, the largest US health insurer, has indicated it is drastically cutting its Affordable Health Care (ACA) public exchange offerings to only three states. This could affect some tens of thousands in the 31 states to be eliminated from the health insurer’s currently served markets. The drastic reduction in its covered health exchange markets comes despite revenues rising by 28 percent in the second quarter of 2016, to $46.5 billion, and profits jumping 13 percent, to nearly $3.4 billion. This is due mainly to profits in the company’s Optum division.

UnitedHealth reports that it has lost more than $1 billion over the last two years on the exchanges run by what is commonly known as Obamacare. This includes an estimated $200 million in losses in “ACA-compliant individual products” in 2016, Forbes reports.

In a telephone call with analysts Tuesday, UnitedHealth CEO Stephen Hemsley said the company now expects to operate “three or fewer exchange markets” in 2017, down from 34 this year. UnitedHealth plans to maintain public exchange offerings only in New York, Nevada and Virginia, pending approvals, Hemsley said.

UnitedHealth cited higher-than-expected enrollment in Obamacare insurance products as the main cause of its projected $200 million losses for 2016. According to Investor’s Business Daily, the insurer had 820,000 exchange customers at the end of June, up by about 25,000 from the end of March. These figures were surprising, as enrollment typically declines for most companies as the year progresses.

UnitedHealth ACA enrollees since March have tended to be sicker, including customers with chronic conditions such as HIV, diabetes and hepatitis C. Under Obamacare, insurers are prohibited from discriminating against those with preexisting conditions. The moves by UnitedHealth to dump the vast majority of their ACA products demonstrate, however, that insurers are free to exit the market if they determine their profits are threatened.

Under the ACA’s “individual mandate,” individuals and families without health insurance from their employer or a government program such as Medicare or Medicaid must purchase coverage from a private insurer on the exchanges or pay a substantial tax penalty. But the insurer companies are under no such obligation to actually provide such coverage.

For UnitedHealth, the real driver of profits and revenue has been the company’s Optum division, which saw revenues soar by 52 percent in the second-quarter, to $20.6 billion. The Optum unit includes OptumRx, a pharmacy benefit management company, which saw a 69 percent growth in revenue in the second quarter, to $15.1 billion, due to growth and acquisitions, according to Forbes .

Through urgent care centers and doctor’s practices it owns, Optum also provides technology services to doctors and hospitals as well as a business providing outpatient care.

The giant insurers can pick and choose where to do business, letting profits and revenue be their guide, as Obamacare is based on the for-profit model. The insurance companies make no pretense that their involvement in the ACA marketplace is driven by altruistic motives.

When insurers do choose to participate in the ACA marketplace there is little meaningful oversight on the prices they charge for premiums. While premiums and the scope of plan networks vary from state to state, a recent Kaiser Family Foundation report showed that the average cost of the second-lowest-cost “silver” plan on the Obamacare marketplaces will rise by 10 percent in 2016, double last year’s rate.

The most affordable ACA plans also come with large deductibles, which must be paid in full before any coverage, except that deemed “essential,” kicks in. Many of the lowest-cost “bronze” plans come with deductibles as high as $5,000 and more.

The Los Angeles Times reports that Obamacare premiums in California will rise by an average of 13.2 percent in 2017, according to state officials. This follows increases of 4.2 percent in 2015 and 4 percent in 2016. Officials had previously boasted that the state’s Covered California program had insured hundreds of thousands of people while keeping costs relatively low.

July 19, 2016

Obamacare Is Failing from Behind

Leading from behind is a business concept where leaders steer their organizations much as shepherds guiding their flocks, from behind. It is contingent on a basic reality, “One can lead from behind only if one knows what lies ahead and what it will take to get there.” President Obama’s foreign policy style has been described as “leading from behind” particularly in the Middle East. Another view of Obama’s style: “A foreign policy of hesitation, delay and indecision.” One look at the current Middle East shows how that is working out.Shifting from foreign to domestic affairs, how has the President’s leadership worked with Obamacare? Does Mr. Obama know what lies ahead and how to get there in the world of healthcare? Or have the past six years since passage of the Affordable Care Act been one of hesitation, delay and indecision? Has the President’s signature piece of legislation, bearing his name, been shepherded forward in a thoughtful and logical manner, responsive to the needs of patients, providers, and the insurance entities footing much of the bill? It’s quite obvious that just as with foreign policy, Obamacare is failing from behind.

Given the run of Obamacare co-op closures, it seems the President is not tending his flock, instead allowing predators, harsh weather, and lack of food to decimate his sheep. This week the Illinois Department of Insurance shut down the Land of Lincoln co-op, leaving nearly 50,000 policyholders high and dry.For those losing their insurance, there is good and bad news. The good news is, “Policyholders will be able to buy insurance from a different carrier to cover them for the rest of 2016.” The bad news is, “The co-pays and deductibles enrollees have been paying since January will not transfer to new plans.” A double whammy for those who have already met their deductible and out-of-pocket maximums for the year and now have to do it all again now. And then again in January 2017.We all remember the President’s big lie, “If you like your health care plan, you can keep it.” Except when insurance companies go broke due to a variety of unfavorable business conditions and regulations. These include essential benefits, making everyone purchase insurance to provide coverage they don’t want or need. Then there is guaranteed issue, allowing one to purchase insurance after they are sick, not quite the concept of insurance. And adverse selection where sick people purchase insurance and healthy people don’t, leaving the insurance companies covering a sick and expensive group of individuals.These forces choked the Illinois exchange. They lost $90 million in 2015 with incoming premiums far below the outgoing healthcare costs of its enrollees. They ran into Captain Obvious, “The newly insured were sicker than carriers had expected.”For all the hype and fanfare, only 11.3 million people have signed up for health insurance under the Affordable Care Act, just over 3 percent of the US population. And in the process, how many more have had their lives and wallets disrupted by Obamacare?Higher premiums are a fact of life under Obamacare. And they continue to go up each year. But that’s only the beginning. Pay the premium to have insurance, not to use it. That carries another cost, the deductible, which must be paid in full before any insurance benefits kick in. Even after you pay the deductible your healthcare is still not free. Don’t forget the copay, anywhere from 10 to 40% of your bill that you must pay, on top of the deductible and monthly premium. This also assumes the doctor or hospital you choose is in-network, otherwise insurance may not cover anything.Imagine a monthly premium of $500 for your family, a $6000 deductible and a 20 percent copay. Pay $12,000 out of pocket to reach the point of having to pay 20 percent of prescriptions, lab tests, doctor visits or hospitalizations. Fortunately, most policies have an out of pocket maximum, but if it’s tens of thousands of dollars, you may be bankrupt before ever reaching the maximum. And this is for the year. Ring in the New Year and the financial clock starts all over again.The Illinois co-op was one of 23 co-ops created under Obamacare. Only 7 remain open for business. Three-quarters of the co-ops have gone the way of Donald Trump’s primary opponents. And of those still open, for how long? What happens when they close? Obama the shepherd has a rapidly thinning flock of insurance co-ops, which he is leading from behind, assuming he even knows where it is going or how to get there. Most of the flock already have been led off a cliff.What if he does know where he is going? What if his goal is well beyond Obamacare into the realm of single-payer? It struck out in Vermont, but is on the ballot in Colorado. Obama is a fan of single-payer plans. Could he actually and cleverly be leading the country from behind into a national single-payer plan, one that Bernie Sanders enthusiastically supports and Hillary Clinton dances around depending on her political audience at the moment.In 2003, as a state senator, Obama said of single-payer, “We may not get there immediately.” As President, has his shepherding of Obamacare been “failing from behind” as it looks to the casual observer? Or is he truly, but craftily, “leading from behind”, using Obamacare to create chaos and financial collapse to the point where the only solution is for a government rescue? It’s looking more and more like the latter option.Brian C Joondeph, MD, MPS, a Denver based retina surgeon, radio personality, and writer. Follow him on Facebook and Twitter.

Leading from behind is a business concept where leaders steer their organizations much as shepherds guiding their flocks, from behind. It is contingent on a basic reality, “One can lead from behind only if one knows what lies ahead and what it will take to get there.” President Obama’s foreign policy style has been described as “leading from behind” particularly in the Middle East. Another view of Obama’s style: “A foreign policy of hesitation, delay and indecision.” One look at the current Middle East shows how that is working out.Shifting from foreign to domestic affairs, how has the President’s leadership worked with Obamacare? Does Mr. Obama know what lies ahead and how to get there in the world of healthcare? Or have the past six years since passage of the Affordable Care Act been one of hesitation, delay and indecision? Has the President’s signature piece of legislation, bearing his name, been shepherded forward in a thoughtful and logical manner, responsive to the needs of patients, providers, and the insurance entities footing much of the bill? It’s quite obvious that just as with foreign policy, Obamacare is failing from behind.Given the run of Obamacare co-op closures, it seems the President is not tending his flock, instead allowing predators, harsh weather, and lack of food to decimate his sheep. This week the Illinois Department of Insurance shut down the Land of Lincoln co-op, leaving nearly 50,000 policyholders high and dry.For those losing their insurance, there is good and bad news. The good news is, “Policyholders will be able to buy insurance from a different carrier to cover them for the rest of 2016.” The bad news is, “The co-pays and deductibles enrollees have been paying since January will not transfer to new plans.” A double whammy for those who have already met their deductible and out-of-pocket maximums for the year and now have to do it all again now. And then again in January 2017.We all remember the President’s big lie, “If you like your health care plan, you can keep it.” Except when insurance companies go broke due to a variety of unfavorable business conditions and regulations. These include essential benefits, making everyone purchase insurance to provide coverage they don’t want or need. Then there is guaranteed issue, allowing one to purchase insurance after they are sick, not quite the concept of insurance. And adverse selection where sick people purchase insurance and healthy people don’t, leaving the insurance companies covering a sick and expensive group of individuals.These forces choked the Illinois exchange. They lost $90 million in 2015 with incoming premiums far below the outgoing healthcare costs of its enrollees. They ran into Captain Obvious, “The newly insured were sicker than carriers had expected.”For all the hype and fanfare, only 11.3 million people have signed up for health insurance under the Affordable Care Act, just over 3 percent of the US population. And in the process, how many more have had their lives and wallets disrupted by Obamacare?Higher premiums are a fact of life under Obamacare. And they continue to go up each year. But that’s only the beginning. Pay the premium to have insurance, not to use it. That carries another cost, the deductible, which must be paid in full before any insurance benefits kick in. Even after you pay the deductible your healthcare is still not free. Don’t forget the copay, anywhere from 10 to 40% of your bill that you must pay, on top of the deductible and monthly premium. This also assumes the doctor or hospital you choose is in-network, otherwise insurance may not cover anything.Imagine a monthly premium of $500 for your family, a $6000 deductible and a 20 percent copay. Pay $12,000 out of pocket to reach the point of having to pay 20 percent of prescriptions, lab tests, doctor visits or hospitalizations. Fortunately, most policies have an out of pocket maximum, but if it’s tens of thousands of dollars, you may be bankrupt before ever reaching the maximum. And this is for the year. Ring in the New Year and the financial clock starts all over again.The Illinois co-op was one of 23 co-ops created under Obamacare. Only 7 remain open for business. Three-quarters of the co-ops have gone the way of Donald Trump’s primary opponents. And of those still open, for how long? What happens when they close? Obama the shepherd has a rapidly thinning flock of insurance co-ops, which he is leading from behind, assuming he even knows where it is going or how to get there. Most of the flock already have been led off a cliff.What if he does know where he is going? What if his goal is well beyond Obamacare into the realm of single-payer? It struck out in Vermont, but is on the ballot in Colorado. Obama is a fan of single-payer plans. Could he actually and cleverly be leading the country from behind into a national single-payer plan, one that Bernie Sanders enthusiastically supports and Hillary Clinton dances around depending on her political audience at the moment.In 2003, as a state senator, Obama said of single-payer, “We may not get there immediately.” As President, has his shepherding of Obamacare been “failing from behind” as it looks to the casual observer? Or is he truly, but craftily, “leading from behind”, using Obamacare to create chaos and financial collapse to the point where the only solution is for a government rescue? It’s looking more and more like the latter option.Brian C Joondeph, MD, MPS, a Denver based retina surgeon, radio personality, and writer. Follow him on Facebook and Twitter.